Provider Demographics
NPI:1346257540
Name:GANTI, AVINASH L (MD)
Entity Type:Individual
Prefix:
First Name:AVINASH
Middle Name:L
Last Name:GANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3407 WILKENS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5072
Mailing Address - Country:US
Mailing Address - Phone:410-646-4888
Mailing Address - Fax:410-646-2828
Practice Address - Street 1:3407 WILKENS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5072
Practice Address - Country:US
Practice Address - Phone:410-646-4888
Practice Address - Fax:410-646-2828
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00621452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI 25355Medicare UPIN